Should I Opt for a Myomectomy To Remove My Fibroid Tumors?

What You Should Know About This Alternative to the Hysterectomy

Woman holding stomach
Getty Images/Vincent Besnault

Fibroid tumors are the justification given for over one-third of the estimated 600,000 hysterectomies performed annually in the United States. But there is another option.

In opting for a myomectomy instead, fibroid tumors can be surgically removed while still preserving the uterus. When performed by an experienced physician, a myomectomy is a safe and effective alternative to a hysterectomy.

What Do I Need to Do to Prepare for a Myomectomy?

Preoperative therapy often includes a monthly injection of Lupron during the two to four months preceding the procedure.

Lupron stops estrogen production, causing the fibroids to shrink in size. During this time, menstruation usually ceases. 

Conflict exists among physicians about the use of Lupron, both because it is expensive and because it causes menopausal symptoms such as hot flashes and night sweats. Some also worry that it may shrink some very small fibroids to a point where they will not be not visible to the physician during surgery and that these unseen fibroids will grow again and possibly require additional surgery.

A myomectomy can be safely performed multiple times but, each time surgery is performed, the risk of pelvic adhesions increases.

A successful myomectomy should provide complete relief from all of the symptoms associated with fibroid tumors. However, fibroids often grow back, necessitating the need for a hysterectomy later on.

What Risks Are Associated with a Myomectomy?

Many physicians who are untrained in performing a myomectomy will opt for a hysterectomy because their lack of experience increases the risk of complications.

Although complications are rare when a myomectomy is performed properly, women considering this procedure should be aware of the possible risks. Possible complications include blood loss, ileus (bowel obstruction), anemia, pain, late intestinal obstruction, infertility, possible conversion to hysterectomy during myomectomy, and subsequent surgery.

Although pregnancy is still possible after a myomectomy, women who become pregnant following a myomectomy face the possible necessity of a cesarean section due to a potential weakening in the uterine wall.

Although more than 99 percent of fibroids are benign, your physician should also discuss the rare possibility of cancer before your myomectomy.

How Is a Myomectomy Performed?

There are several ways to perform a myomectomy. It can be performed vaginally or abdominally, using a variety of different methods. The type of myomectomy chosen depends on the size and location of the fibroid tumors.

After a woman is under anesthesia, a catheter is inserted into the bladder to keep it empty during the procedure. Another catheter is then inserted into the uterus and a blue dye is injected to stain the uterine cavity; this staining of the uterine cavity is necessary to help the physician determine the location of the fibroids, which often are so large they are indistinguishable from the tissue of the uterus.

The blue dye also runs into the fallopian tubes and allows the physician to determine whether they are blocked or open. Repairs to the fallopian tubes can also be made during this procedure.

Next, a drug is injected into the first fibroid slated for removal, causing the blood supply to stop for 20 minutes and allowing the physician to remove the fibroid with less risk of excessive bleeding and transfusion.

Special care must be taken when closing up the defect (space) left where the fibroid was removed. Each layer of tissue must be sutured individually to prevent clots and other complications. As each fibroid is removed, this procedure is repeated.

All women undergoing a minimally invasive myomectomy technique should be aware of the possible need to convert to a traditional abdominal procedure while the myomectomy is in progress.

As previously mentioned, there are several ways to perform a myomectomy.

Trans-cervical Myomectomy

This is performed during a hysteroscopy with the aid of a resectoscope to treat submucosal fibroids. Other types of myomectomy may be performed during this procedure if intramural or subserosal fibroids are present.

Laparoscopic Myomectomy

This is a procedure that removes the fibroids and repairs the defect left where the fibroid was located.

Proper repair of the defect is of extreme importance in the prevention of complications. A small incision is made, usually in the navel, and a laparoscope is inserted where the myomectomy is performed. This type of myomectomy offers the fastest recovery time.

Laparoscopic Myomectomy with Colpotomy

This is a procedure that involves an incision in the vagina to remove large pieces of fibroids. This procedure does not close the defect left by the fibroid and must be performed in conjunction with another procedure.

Laparoscopic Minilap Myomectomy

This is a procedure that also includes a small traditional abdominal incision to remove the fibroids. This type of procedure can be used for any size of fibroid. Because the incision is only 4-5 cm, recovery is quicker than from a conventional myomectomy.

Conventional Myomectomy

This is still the most commonly performed type of myomectomy, as laparoscopic myomectomies are more difficult to perform.

A traditional myomectomy requires a 5-7 inch abdominal incision, three to five days of hospitalization, and six to eight weeks for recovery.

Questions to Ask Your Physician

  • Why are you recommending a myomectomy now?
  • What are the risks if I decide against myomectomy? 
  • How often do you perform myomectomies?
  • Can you perform a myomectomy without regard to the size or location of fibroids? 
  • What type of myomectomy are you advising for me? Why? 
  • Will I require blood transfusions

Remember, your physician should explain all possible options before you make your decision. If your physician does not offer myomectomy for fibroids and insists on hysterectomy, it is most likely because he is not experienced enough to safely perform a myomectomy, and you should ask him for a referral to a physician who is experienced in performing a myomectomy. A good physician will gladly give you such a referral and a second opinion is always a wise choice before any major surgery.

Source:

Uterine Fibroids. ACOG Education Pamphlet AP074. http://www.acog.org/publications/patient_education/bp074.cfm. Accessed 08/24/09.

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